• Brian P Villa, Sandra M Farach, Vic Velanovich, Emily Coughlin, Parker Penny, Jonathan Henning, Steven Lorch, Thomas Herron, Rahul S Mhaskar, and Jose J Diaz.
• Morsani College of Medicine, University of South Florida, 560 Channelside Drive Tampa, FL.
• J. Am. Coll. Surg. 2025 Jan 23.

BackgroundFirearm violence in America has been declared a public health crisis. This study investigates variation in firearm injuries by county-level characteristics and intent of firearm use.Study DesignThe open-access FLHealthCHARTS was searched for firearm injuries from 1989-2022. Intentional firearm injury rates (IFIR) and unintentional firearm injury rates (UFIR) were collected as the number of injuries per 100,000 citizens, race and ethnicity. They were then stratified by severity of injury across county-level characteristic categories such as ruralness, Distressed Communities Index (DCI), and Concealed Carry Weapons (CCW) permit rates.ResultsOf 123,484 firearm injuries reported, 109,745 were intentional and 13,739 unintentional. Since the late 1990s intentional firearm related deaths and hospitalizations have increased over time, with higher rates in socioeconomically at-risk and larger counties. Unintentional non-fatal hospitalizations have increased exponentially, with higher rates in distressed counties, but no effects of county size or ruralness. Unintentional deaths declined over time, with no significant county-level effects. Based on heatmap patterns, white citizens appear to be victims of more intentional firearm injuries in rural areas, while Black citizens were victims of more intentional firearm injuries in urban areas. The rate of CCW permit holders did not correlate to changes in UFIR or IFIR but patterns can be identified on a county-by-county basis.ConclusionThese results suggest that deaths remain a problem in all Florida county communities while hospitalizations are highly influenced by socioeconomic factors and county size. Heatmaps may inform level one trauma hospitals to implement tailored education for high risk surrounding communities.Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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